Provider Demographics
NPI:1235381948
Name:KARIN LINDHOLM, D.O.
Entity Type:Organization
Organization Name:KARIN LINDHOLM, D.O.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-455-1400
Mailing Address - Street 1:901 N CURTIS RD STE 403
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1342
Mailing Address - Country:US
Mailing Address - Phone:208-367-5857
Mailing Address - Fax:
Practice Address - Street 1:901 N CURTIS RD STE 403
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1342
Practice Address - Country:US
Practice Address - Phone:208-367-5857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID0-1592084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010000939OtherBLUE SHIELD
IDS2426OtherBLUE CROSS
ID002457400Medicaid